Disabled Throwing Shoulder: 2021 Update: Part 2—Pathomechanics and Treatment
William Ben Kiblera, Aaron D Sciasciab c✉, John Tokishd, John D. A. Kellye, Stephen John Thomasf, James P. Bradleyg, Michael M. Reinoldh i j, Michael G. Ciccottik
- aShoulder Center of Kentucky, Lexington Clinic, Lexington, Kentucky, U.S.A
- bDepartment of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky, U.S.A.. Electronic address: ascia@lexclin.com
- cDepartment of Exercise and Sport Science, Eastern Kentucky University, Richmond, Kentucky, U.S.A
- dOrthopedic Sports Medicine Fellowship, Mayo Clinic Arizona, Phoenix, Arizona, U.S.A
- eShoulder Sports Medicine, Penn Perleman School of Medicine, Philadelphia, Pennsylvania, U.S.A
- fDepartment of Exercise Science, Jefferson College of Rehabilitation Science, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A
- gUniversity of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- hChampion PT and Performance, Boston, Massachusetts, U.S.A.
- iChicago White Sox, Chicago, Illinois, U.S.A
- jChampion PT and Performance, Boston, Massachusetts, U.S.A
- k
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Abstract
The purpose of this paper is to provide updated information for sports healthcare specialists regarding the disabled throwing shoulder (DTS). A panel of experts, recognized for their experience and expertise in this field, was assembled to address and provide updated information on several topics that have been identified as key areas in creating the DTS spectrum. Each panel member submitted a concise presentation on one of the topics within these areas, each of which were then edited and sent back to the group for their comments and consensus agreement in each area. Part two presents the following consensus conclusions and summary findings regarding pathomechanics and treatment, including (1) internal impingement results from a combination of scapular protraction and humeral head translation; (2) the clinically significant labral injury that represents pathoanatomy can occur at any position around the glenoid, with posterior injuries most common; (3) meticulous history and physical examination, with a thorough kinetic chain assessment, is necessary to comprehensively identify all the factors in the DTS and clinically significant labral injury; (4) surgical treatment should be carefully performed, with specific indications and techniques incorporating low profile implants posterior to the biceps that avoid capsular constraint; (5) rehabilitation should correct all kinetic chain deficits while also developing high-functioning, throwing-specific motor patterns and proper distribution of loads and forces across all joints during throwing; and (6) injury risk modification must focus on individualized athlete workload to avoid overuse. LEVEL OF EVIDENCE: V, expert opinion.